Mr. Schilling (for
himself, Mr. Hultgren,
Mr. McKinley,
Mr. Schock, and
Mr. Walsh of Illinois) introduced the
following bill; which was referred to the Committee on Veterans’
Affairs

A BILL

To amend title 38, United States Code, to direct the
Secretary of Veterans Affairs to enter into contracts with health care
providers to improve access to health care for veterans who have difficulty
receiving treatment at a health care facility of the Department of Veterans
Affairs, and for other purposes.

1.

Short title; sense of
Congress

(a)

Short
title

This Act may be cited
as the Enhanced Veteran Healthcare
Experience Act of 2011.

(b)

Sense of
Congress

It is the sense of
Congress that—

(1)

the current health care system of the
Department of Veterans Affairs is neither fiscally efficient nor effective in
providing easily accessible treatment for all veterans;

(2)

health care can be provided more
efficiently to provide veterans with care that is available closer to where
they live and to allow veterans more flexibility in choosing their own doctors;
and

(3)

better health care can be provided to
veterans at little-to-no increased cost to the taxpayer by replacing the
fee-based care system of the Department with the veterans enhanced care
program, as described under section 2, and reprogramming funds to this
program.

2.

Enhanced contract care
authority for health care needs of veterans

(a)

In
general

(1)

Type of
care

Subsection (a) of section 1703 of title 38, United States
Code, is amended to read as follows:

(a)(1)

The Secretary shall provide an eligible
veteran with covered health services that are provided by a non-Department
provider whom the Secretary enters into a contract with under this section if
the Secretary determines that facilities of the Department are not capable
of—

(A)

economically furnishing covered health
services to such veteran because of geographical inaccessibility; or

(B)

furnishing covered health services to such
veteran because such facilities lack the required personnel, resources, or
ability.

(2)

In this subsection:

(A)

The term covered health
services means, with respect to an eligible veteran, any hospital care,
medical service, rehabilitative service, or preventative health service that is
authorized to be provided by the Secretary to the veteran under this chapter or
any other provision of law.

(B)

The term eligible veteran
means a veteran enrolled in the health care system established under section
1705(a) of this title who elects to receive care under this
section.

.

(2)

Qualified
providers; quality of care

Such section is amended by adding at
the end the following new subsections:

(e)

The Secretary may enter into a contract
with a non-Department provider under this section if such provider—

meets or exceeds internal credentialing
standards of the Department and standards of the Utilization Review
Accreditation Commission;

(3)

has care coordinators who help veterans
make, confirm, and keep medical appointments;

(4)

has—

(A)

a system that
allows veterans to file complaints; and

(B)

a demonstrated
ability to respond to potential quality indicators and patient safety events;
and

(5)

has the ability to—

(A)

process claims
from others in the network of the provider;

(B)

bill a third party
(as defined in section 1725(f)(2) of this title) for care provided under this
section, as appropriate; and

(C)

transmit directly
to the Secretary any amounts received pursuant to subparagraph (B).

(f)

In carrying out
this section, the Secretary shall ensure the following:

(1)

With respect to
each medical center of the Department, the Secretary is consistent in
determining the eligibility of veterans under subsection (a).

(2)

The Secretary
includes care coordinators of a non-Department provider described in subsection
(e)(3) in initiatives of the Department to provide patient-centered care and
uses such coordinators when the Secretary is unable to assign a veteran a case
manager from the Department.

(3)

The Department and
a non-Department provider under this section exchange clinical information to
improve both clinical decision-making and the care a veteran receives.

(4)

Both non-Department facilities under this
section and Department facilities meet performance metrics regarding—

(A)

the quality of
health care provided; and

(B)

the satisfaction
of veterans.

(5)

A non-Department facility under this
section or employee of the Department who exceeds performance metrics under
paragraph (4) are eligible for incentive or bonus payments.

(g)(1)

Not later than October 31 of each year, the
Secretary shall submit to the Committee of Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a report on
care provided under this section, including—

(A)

the cost to the Department;

(B)

the number of veterans receiving care
under this section;

(C)

the quality of such care and the
satisfaction of such veterans; and

(D)

other matters the Secretary considers
appropriate.

(2)

Not later than March 1 of each odd-numbered
year, the Secretary shall submit to the Committee of Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of Representatives a
report on the allocation of resources with respect to care provided by the
Department and by non-Department
facilities.

.

(3)

Effective
date

The amendments made by paragraphs (1) and (2) shall take
effect on October 1, 2012.

(b)

Authorization of
appropriations

There is authorized to be appropriated to the
Secretary to carry out section 1703 of title 38, United States Code, as amended
by this section, for fiscal year 2013 $5,000,000,000.

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